Bilingual (Spanish) Field LTSS Service Coordinator-RN Clinician - Remote in New York City, NY (Bronx

Employment Type

: Full-Time


: Healthcare - Nursing

Your Talent. Our Vision. At Empire Blue Cross Blue Shield, a proud member of the Anthem, Inc. family of companies, it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine. We are a 5 Star Health Plan!

This is a Field LTSS Service Coordinator RN position supporting our Medicaid members requiring LTSS (long term services and supports) benefits. You will travel in your own vehicle (mileage reimbursed) throughout the Bronx area of New York City meeting with members where they live to complete assessments for services. When not in the field, you will have training and equipment to work from a home office. You must have a high speed internet connection. You will be working from home and in the field. Potential for flexible work week schedule. Great opportunity for career and education advancements.

Location: New York City (Bronx), NY

The LTSS Service Coordinator- RN Clinician is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum.

* Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social services and long term services and supports.

* Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team.

* Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.

* Obtains a thorough and accurate member history to develop an individual care plan.

* Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs.

* The RN has overall responsibility to develop the care plan for services for the member and ensures the member's access to those services.

* May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible.

* Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plans.

* May also assist in problem solving with providers, claims or service issues.

* May direct the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by, for example, assigning appropriate tasks to the non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the member's care plan to meet the member's needs, and reviewing and providing input on the non-RN clinicians' performance on a regular basis.

* Requires a Nursing Diploma or AS in Nursing or a related field; 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, Advocate or similar role; or any combination of education and experience, which would provide an equivalent background.
* Current unrestricted RN license in the state of New York required.
* Medicaid, managed care experience preferred.
* Home health/field experience required.
* Travel required around New York City.
* Computer skills: MS Word, Outlook, Excel.
* Knowledge of UAS (Universal Assessment Tool) required.
* Bilingual in Spanish required.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.

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